The Impact of Sonothrombolysis on Left Ventricular Diastolic Function and Left Atrial Mechanics Preventing Left Atrial Remodeling in Patients With ST Elevation Acute Myocardial Infarction

Hsu Po Chiang, Miguel O.D. Aguiar, Bruno G. Tavares, Vitor E.E. Rosa, Sergio Barros Gomes, Mucio T. Oliveira, Alexandre Soeiro, Jose C. Nicolau, Henrique B. Ribeiro, João C. Sbano, Carlos E. Rochitte, Roberto Kalil Filho, Jose A.F. Ramires, Thomas R. Porter, Wilson Mathias, Jeane M. Tsutsui

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Background: The diagnostic ultrasound-guided high mechanical index impulses during an intravenous microbubble infusion (sonothrombolysis) improve myocardial perfusion in acute ST segment elevation myocardial infarction, but its effect on left ventricular diastolic dysfunction (DD), left atrial (LA) mechanics and remodeling is unknown. We assessed the effect of sonothrombolysis on DD grade and LA mechanics. Methods: One hundred patients (59 ± 10 years; 34% women) were randomized to receive either high mechanical index impulses plus percutaneous coronary intervention (PCI) (therapy group) or PCI only (control group) (n = 50 in each group). Diastolic dysfunction grade and LA mechanics were assessed immediately before and after PCI and at 48 to 72 hours, 1 month, and 6 months of follow-up. Diastolic dysfunction grades were classified as grades I, II, and III. The LA mechanics was obtained by two-dimensional speckle-tracking echocardiography–derived global longitudinal strain (GLS). Results: As follow-up time progressed, increased DD grade was observed more frequently in the control group than in the therapy group at 1 month and 6 months of follow-up (all P < .05). The LA-GLS values were incrementally higher in the therapy group when compared with the control group at 48 to 72 hours, 24.0% ± 7.3% in the therapy group versus 19.6% ± 7.2% in the control group, P = .005; at 1 month, 25.3% ± 6.3% in the therapy group versus 21.5% ± 8.3% in the control group, P = .020; and at 6 months, 26.2% ± 8.7% in the therapy group versus 21.6% ± 8.5% in the control group, P = .015. The therapy group was less likely to experience LA remodeling (odds ratio, 2.91 [1.10-7.73]; P = .03). LA-GLS was the sole predictor of LA remodeling (odds ratio, 0.79 [0.67-0.94]; P = .006). Conclusion: Sonothrombolysis is associated with better DD grade and LA mechanics, reducing LA remodeling.

Original languageEnglish (US)
Pages (from-to)504-513
Number of pages10
JournalJournal of the American Society of Echocardiography
Volume36
Issue number5
DOIs
StatePublished - May 2023

Keywords

  • Acute myocardial infarction
  • Left atrial remodeling
  • Left atrial strain
  • Left ventricular diastolic dysfunction
  • Sonothrombolysis

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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